Since the Patient Protection and Affordable Care Act was signed into law, those throughout the health care system, as well as the media, have been primarily focused on the near-term impact that reform will have on individual and group medical benefits. What hasn't received as much coverage is how dental benefits will ultimately be impacted by the new reform law.

Although the impact of reform is not as great to dental as it is for medical, and there does not appear to be an immediate impact to dental coverage, it is important to note that the new reform law will indeed effect dental benefits.

There may be some confusion right now as to what provisions may or may not apply to dental benefits, so we've included a quick synopsis below to help provide some clarity.

Please note, the information below reflects what is currently believed throughout the dental industry, but it is subject to change as the detailed rules of the Health Care Reform law are written over the coming months.

Which provisions do not impact dental coverage?

    * Extension of Dependent Age Limit to 26 - medical only
    * Removal of Lifetime Dollar Limits - medical only
    * Removal of Annual Maximums - medical only
    * Tax on high-value benefits plans (aka “Cadillac Tax”) - medical only

Which provisions will impact dental coverage?

    * New annual fee being imposed on Health Insurance providers (beginning 2013)
To help fund health care reform, health insurers will be subject to a new annual fee beginning in 2013. Each carrier's fee will be based on their specific 2013 market share – total insured premium for medical, dental and vision.
Potential impact: Pricing for dental benefits could increase to reflect the new annual fee that health insurers will be required to pay

    * Pediatric dental coverage provision (beginning in 2014)
Health Insurers will be required to package pediatric dental and vision benefits with a medical plan as part of the “Essential Health Benefits Package” (EHBP) in the individual and Small Group market (100 or fewer employees). At this point, standalone dental plans sold through the state-sponsored insurance Exchanges (to be established in 2014) can be used to satisfy the pediatric dental requirement.
Potential impact: Details around this specific provision are still being clarified, but there is the potential that this provision will impact both the purchasing of standalone dental benefits, as well as administration of those plans. Guardian will go into more detail on this specific provision in a future Legislative Update.


For the most up-to-date information on reform, we encourage you to visit America's Health Insurance Plans or the National Association of Health Underwriters (NAHU) at .
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